HomeMy WebLinkAboutBuilding Permit 00-0759
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. DATE
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SIT DDRE 1
3. LEGAL DESCRIPTION
LOT
ADDITION
4.0
\
?I'\ur
BLOCK :;;:I,
Ac f'U>
5. ARCHITECT
ar-et
AB~1 W'\ b:Sfum ~O&Vor ;ddre\h4'l1\l\~4~. ~~;:
oJ ' /Ast{
7. TYPE OF WORK
New Construction 0
Septic D
Addition 0
Fireplace D
Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
DeckLl
Finish Attic 0
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
YllS No
tt7tf2-
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 00- 0 "1SCf
BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
[:'14. FLOOR AREA APPORTIONMENT USE
.t- .
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
15. PROJECT COSTNALUE
17. COMPLETION DATE
I hereby certify that I have furnished information on this application which is to the besl of my knowledge true and correct. I also certify that I am the owner or authorized agent for
the above mentioned propel1Y nd that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bu'ld official can revok it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections,
^) () 11093'11.3 s- 2.2. ~ OD
license No, Date
x
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING -12 0 >. ~-J2
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
FOR ADMINISTRATIVE USE
Back
Side
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
ryLJ. "1S
*
I, ~S-
Amount Brought Forward .................. $
ParkSupportFee ........................... $
SAC ......................................... $
Collective Street Fee ......... .... .... ...... $
Sewer Tap ................................... $
$
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
S U
City:
Pressure Reducer .......................... $
Meter Ham ........... ........................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 'I c,. t:?{)
Paid UO Receipt No. %" ~-6
Gas Fireplace Permit ...... .............. $
P itWhe~roV%
at ~ '} J
Issued
Date
This is to certify that the request in the above application and accompanying documents is in aCGordance with the City Zonin Ordina e and may proceed
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate
City Planner
Data
Special Condrtions if any
24 hour notice for aU inspections 447-9850
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
rd#
PHONE NO.
16011
CAMBRIDGE
00-0759
Re-Roof
ADDRESS
OWNER
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~p ~ / /
~" (~P/e -r€-
'"
~RKSATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Conlr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETYI
INSNOTJ